Even though autologous hematopoietic stem cell transplantation (AHCT) is an effective treatment for multiple myeloma, only 4 out of 10 patients receive this therapy. A new study presented by Munshi et al at the 2019 American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 782) has shown AHCT is safe and effective in older patients, and suggests that more people could benefit from the therapy than have typically been offered it.
Older people are often excluded from clinical trials studying transplant because they tend to have a greater number of health issues. Without trials proving newer, aggressive treatments are safe for older patients, doctors may avoid them on the assumption that they are too risky. In addition to showing AHCT is safe and effective in patients over 70 years old, researchers also found patients fared better when given melphalan in the normal dose of 200 mg/m2, rather than the reduced dose of 140 mg/m2 often given to older patients.
Anita D’Souza, MD
“This study shows that you can perform these transplants safely in older patients, and the older patients get the same benefits from these treatments as the younger patients do,” said lead study author Anita D’Souza, MD, of the Medical College of Wisconsin. “In addition, if there are no contraindications other than simply age, it’s worth trying the higher dose of melphalan. Age alone should not be a reason to automatically reduce the dose.”
Methods and Findings
Using the Center for International Blood and Marrow Transplant Research database, the researchers examined health records of approximately 16,000 patients who received AHCT with melphalan in the United States between 2013 and 2017.
After adjusting for factors such as functional status, comorbidities, and disease stage, they found patients who received treatment at age 70 or older had similar rates of relapse or disease progression, progression-free survival, and death not caused by a cancer relapse as those aged 60 to 69 years.
Among patients aged 70 and older, about 40% received the full dose of melphalan and 60% received a reduced dose. Those receiving the reduced dose had significantly worse outcomes and lower survival rates. However, Dr. D’Souza noted that it is impossible to determine whether these patients were also more frail to begin with, in which case, their poorer outcomes would not necessarily be due to the dosing reduction.
While AHCT specialists often support the use of AHCT in otherwise healthy older patients, Dr. D’Souza said oncologists in community hospitals where many patients are first treated often do not refer older patients to transplant centers. The researchers noted a significant increase in the proportion of older patients receiving AHCT in 2017 compared to 2013, suggesting that referrals to AHCT specialists increased over time.
The study also strengthens the argument that people should not be excluded from clinical trials based on age alone, Dr. D’Souza noted.
Disclosures: For full disclosures of the study authors, visit ash.confex.com.The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.